Academic journal article International Perspectives on Sexual and Reproductive Health

Individual- and Community-Level Influences on the Timing of Sexual Debut among Youth in Nyanza, Kenya

Academic journal article International Perspectives on Sexual and Reproductive Health

Individual- and Community-Level Influences on the Timing of Sexual Debut among Youth in Nyanza, Kenya

Article excerpt

Although the global prevalence of HIV and AIDS has declined substantially, Sub-Saharan Africa continues to have the largest share of the global HIV burden. (1) In Kenya, the prevalence of HIV has stabilized in recent years at 6%. (2,3) It is important to acknowledge, however, that HIV prevalence differs among the country's various demographic groups and regions. For instance, individuals aged 15-24 continue to be disproportionately affected by the epidemic and account for about 60% of new HIV infections. (3) Also, Nyanza Province, which borders Lake Victoria in southwestern Kenya, has a prevalence of 15-20%, the highest of any province in the country. (3,4) The HIV burden among youth in this province is particularly high (22%), (3) and young women are twice as likely as young men to be HIVpositive. (5) The vulnerability of youth in Nyanza to HIV is attributable in part to risky sexual behaviors, including early sexual debut; sexual intercourse begins earlier for youth in Nyanza than for their counterparts in other parts of the country. (6) Compared with their same-aged peers, young people who initiate sex at an early age are sexually active for a longer period of time, are more likely to have multiple partners and have an increased risk of contracting HIV. (7-10) Delaying initiation of intercourse has thus become a prime goal for interventions in Sub-Saharan Africa. (11,12)

Previous studies that examined the timing of first sexual intercourse among youth, including our own work, have focused largely on individual-level variables. (13-16) Although a few studies have acknowledged the relevance of structural and community variables, they have rarely established empirical connections between these variables and sexual debut. (4,17-19) This study, which applies multilevel discrete-time hazard models to data collected from youth in Nyanza, fills an important research gap by examining the association of both individual-level and school-and community-level variables with the timing of first sexual intercourse. The addition of school and community variables is crucial, given that effective and well-designed HIV prevention programs usually attempt to achieve results at multiple levels (e.g., individual, school, community).

THEORETICAL PERSPECTIVES

To examine youths' vulnerability to risky sexual behaviors (operationalized here as early sexual intercourse), we adopt two theoretical models: the Information-Motivation-Behavioral Skills (IMB) model developed by Fisher and Fisher (20,21) and Catherine Campbell's community characteristics framework. (22) The IMB model has demonstrated effectiveness in predicting HIV risk behaviors, including sexual initiation, and has been particularly useful in designing HIV intervention programs. (20,21,23) The model specifies that individuals will engage in self-protective behaviors, such as delaying sexual debut, when they know that such behaviors reduce their risk of infection, are motivated to engage in the behaviors, and have the requisite skills and self-efficacy to do so.

In our earlier application of the IMB model to Kenyan and Nigerian data, all components of the model proved useful in explaining the timing of first sex. (4) However, our use of only individual-level variables limited the predictive power of those models; some researchers have observed that models of health behavior that focus exclusively on cognitive and intrapersonal measures have limited relevance and that the culture, socioeconomic environment (24-26) and structural contexts in which individual-level decisions are made must also be examined. (22,25,27) Others have noted that research has largely overlooked the role of community-level variables in shaping the sexual behaviors and reducing the HIV risks of adolescents in Sub-Saharan Africa. (28,29) In particular, there is a dearth of research on and a lack of understanding of how such structural characteristics are associated with the timing of sexual debut. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.